The CC combo: Collagen and Vitamin C for tendon and ligaments

No one likes to be out of action due to injury, but with the right nutrition and rehabilitation program, you can be back on your feet in no time.

While you are completing repair and strengthening exercises with a physical therapist, it is a good idea to provide all the nutritional ingredients your body needs to rebuild healthy and flexible tendons and ligaments.

Collagen peptides have been proven as a nutrition solution to support strong and flexible tendons and ligaments in athletes, contributing to high performance and fast return-to-training, but recent studies have helped to fine tune dosage recommendations and nutrient combinations to enhance its effectiveness. Although thought of for rehabilitation, master athletes may benefit from prophylactic collagen supplementation as the body produces lower-quality  and volumes of collagen as we age.

What does collagen do?

Collagen is one the major structural protein and building blocks made within your body. Collectively collagen comprises 30% of the body’s protein as amino-acids, specifically glycine, proline, hydroxyproline and arginine.  Collagen provides structure and acts like a glue to your skin, hair, skeleton, tendons, muscles, ligaments, corneas, teeth and blood vessels.

There are 16 different types of collagen within the body, all with slightly different roles but 80 – 90 percent of the collagen in the body consists of types I, II, and III.  Together all forms of collagen serve the same purpose; to help tissues withstand stretching. Although all forms are essential in the body, research tends to focus on types I-III when it comes to athletes.

Type I collagen forms the reinforcing rods in bone, cartilage, tendons, teeth and connective tissue and is the most dominant form within the body making up 90% of all collagen. It is also the collagen that forms scar tissue.

Type II collagen (also known as hyaline or articular cartilage) is the major collagen in elastic cartilage and is the gel like substance designed to provide cushioning and allow joints to absorb shock. Its rigid macromolecules provide a strength and compressibility that allow it to resist large deformations in shape during movement.

Type III collagen supports the structure of muscles, organs, and arteries.

Evidenced Based Nutritional Support

When it comes to repairing tendons and ligaments, collagen is the most widely researched supplement.

As a preventative measure for predisposed athletes (master athletes, or athletes with chronic injuries), a daily dose of collagen may be beneficial  When it comes to repairing tendons and ligaments, collagen is the most widely researched supplement. As a preventative measure for predisposed athletes (including masters and those with chronic injuries), a daily dose of collagen may be beneficial.  Recent studies have also shown the combination of 500mg vitamin C and between 5 grams and 15 grams of collagen is beneficial when taken an one hour before exercise. Positive results do not appear to be dose dependent when within this range. Several studies including a study from the AIS (Australia Institute of Sport) showed significant improvements in Achilles tendon injuries with 5g of collagen daily, for three to six months (Praet et al. 2017). Zdzieblik et al. (2017) also demonstrated significant improvements in activity-related joint pain in 139 athletes, while Dressler et.al (2018) showed positive changes to ankle function and pain following an ankle sprain. The daily ingestion of 5g of collagen also reduced the risk of subsequent sprains in the 3-month follow-up period.

A 24-week study by Clark et al. involving 147 athletes showed significant improvement of joint pain using 10 grams of collagen hydrolysate when compared to the placebo group.

Although most collagen products on the market are animal-derived, one 2017 study by Lopez et al involving AyuFlex improved joint function and reduced knee pain in 105 overweight but otherwise healthy individuals in 84 days. AyuFlex is a collagen product derived from Terminalia chebula fruit which is traditionally used in Iranian medicine. Further research is required to substantiate its effectiveness in athletes.

Most collagen powders on the market are derived from shellfish, beef, chicken or pork. All of these sources will provide the amino acid building blocks to form your own collagen in the body, not just type 1 or 11, but every type, so don’t be fooled by great marketing hype. As a general recommendation, better quality collagen supplements are derived from grass fed animals or wild caught seafood. There are no current studies using vegan based collagen options published to date, however plantbased athletes may still be able to boost their collagen production through sufficient amino acids and key nutrient supplementation.

In the initial phase of collagen manufacture the body combines glycine and proline with the help of vitamin C dependant enzymes.   Lis & Baar, (2019) and Shaw et.al (2017) found vitamin C enriched gelatin improves collagen synthesis and could play a beneficial role in injury prevention and tissue repair at both 5 gram and 15 gram doses when taken an one hour before exercise. Preclinical studies have also shown vitamin C has the potential to accelerate bone healing after a fracture, increased type I collagen synthesis, and reduce oxidative stress parameters.

Additional dietary intake of vitamin C rich foods during rehabilitation may also be beneficial. Good sources include berries, red capsicum, broccoli, kiwi, guava, citrus, rosehip and indigenous foods such as camu camu, goji berry and Kakadu plum.

Other beneficial nutrients

Copper also plays a role in collagen production as it activates an enzyme called lysyl oxidase that is required for collagen maturation.  Copper is found in beef liver, crab, oysters, sunflower and sesame seeds, cocoa powder, cashews, hazelnuts, peanuts, almonds and lentils.

Zinc serves as a cofactor for collagen synthesis and activates collagenase, a protein that remodels collagen during wound healing. Zinc is found in seafood, oysters, pepitas, nuts, poultry and meat.

Manganese activates enzymes such as prolidase that your cells use to make proline and gives collagen fibres their shape. Brown rice, oats, pineapple, peanuts, and pecans all contain manganese.

Amino Acids

Insufficient protein intake or overall energy intake will impede wound healing and increase inflammation to possibly deleterious levels. During the healing process, energy expenditure is increased, particularly if the injury is severe. Energy expenditure may be increased  between 15% – 50%, depending on the type and severity of the injury.

Given that muscle loss may begin from inactivity during an injury recovery phase within 36 hours and healing processes are heavily reliant on synthesis of collagen and other proteins, the importance of dietary protein should not be understated. If you are in the unfortunate position of being injured, protein intake of 2 grams/ kg of body weight per day is advocated by researchers such as Frankenfield (2006). Meat, poultry, seafood, dairy, legumes, and tofu are all excellent sources of amino acids. Plant based athletes may combine protein sources to ensure all essential amino acids are available for protein synthesis.

In addition, specific foods rich in proline and glycine may be beneficial.

Proline is found in egg whites, wheat germ, dairy products, cabbage, asparagus, and mushrooms.

Glycine is found in the skin of pork or chicken and gelatin.

Making your own gelatin chews are an easy way to boost glycine intake.

Gelatin is what is used to set jelly and gummy lollies. Gelatin also contains proline, valine, hydroxproline and glutamic acid. Making your own gelatin chews is an easy way to boost glycine intake. Adding vitamin C powder to the gelatin mix can improve the taste and provide additional healing benefits as mentioned above. This gelatin chews recipe has just three ingredients and is very easy to make.  Chews are a handy post training protein snack even if you don’t have injury issues. See the recipe here

If you would like to make your own gelatin you are can prepare it at home in a similar way to making bone broth  by simmering bones (from any animal) in water over a low heat for up to 48 hours. The longer it cooks, the more gelatin you’ll extract.  If you don’t have time to make it yourself, gelatin is readily available in supermarkets in sheets or powder form.

Be wary of the S-word!  Sugar interferes with collagen’s ability to repair itself. It is therefore a good idea to limit your consumption of added sugar and refined carbs when injured for several reasons.

Please remember the guidelines provided in this blog are general in nature. If you are injured, you may benefit from individualised nutritional guidance to help you get back on track. We would love to be part of your recovery support team if this is the case.  Make an appointment here

If you enjoy delving into the science as much as I do, the key references mentioned in this article are included below.

References

Clark, K. L., Sebastianelli, W., Flechsenhar, K. R., Aukermann, D. F., Meza, F., Millard, R. L.,  & Albert, A. (2008). 24-Week study on the use of collagen hydrolysate as a dietary supplement in athletes with activity-related joint pain. Current medical research and opinion24(5), 1485-1496.

Dressler, P., Gehring, D., Zdzieblik, D., Oesser, S., Gollhofer, A., & König, D. (2018). Improvement of functional ankle properties following supplementation with specific collagen peptides in athletes with chronic ankle instability. Journal of sports science & medicine17(2), 298.

Frankenfield, D. (2006). Energy expenditure and protein requirements after traumatic injury. Nutrition in Clinical Practice21(5), 430-437.

Lis, D. M., & Baar, K. (2019). Effects of Different Vitamin C–Enriched Collagen Derivatives on Collagen Synthesis. International journal of sport nutrition and exercise metabolism29(5), 526-531.

Lopez, H. L., Habowski, S. M., Sandrock, J. E., Raub, B., Kedia, A., Bruno, E. J., & Ziegenfuss, T. N. (2017). Effects of dietary supplementation with a standardized aqueous extract of Terminalia chebula fruit (AyuFlex®) on joint mobility, comfort, and functional capacity in healthy overweight subjects: a randomized placebo-controlled clinical trial. BMC complementary and alternative medicine17(1), 475.

Praet, S. F., Purdam, C. R., Welvaert, M., Vlahovich, N., Lovell, G., Burke, L. M., & Waddington, G. (2019). Oral supplementation of specific collagen peptides combined with calf-strengthening exercises enhances function and reduces pain in achilles tendinopathy patients. Nutrients11(1), 76.

Shaw, G., Lee-Barthel, A., Ross, M. L., Wang, B., & Baar, K. (2017). Vitamin C–enriched gelatin supplementation before intermittent activity augments collagen synthesis. The American journal of clinical nutrition105(1), 136-143.

Zdzieblik, D., Oesser, S., Gollhofer, A., & König, D. (2017). Improvement of activity-related knee joint discomfort following supplementation of specific collagen peptides. Applied Physiology, Nutrition, and Metabolism42(6), 588-595.

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